By - At Sutter Health, a major health system headquartered in Northern California, public health reporting was once a manual and burdensome process. However, implementing a clinical direct messaging tool in the EHR has enhanced the electronic case reporting (eCR) process and increased interoperability between the provider and public health agencies.
eCR is the automated production and submission of reportable diseases and conditions from the EHR to public health agencies, according to the Center for Disease Control & Prevention.
eCR is made up of data from The Association of Public Health Laboratories (APHL), the Council of State and Territorial Epidemiologists (CSTE), and the CDC each play a role in facilitating eCR. Specifically, they work with providers in reporting certain conditions, as well as the public health agencies and vendors that enable eCR.
Although public health agencies see the importance of a clinical direct messaging service that enables safe and secure transmission of eCR, there is a widescale public health need to for agencies to take the next step to accept, receive, and integrate eCR data into their workflow.
“They’ve got these archaic, paper-based processes because none of this has been a big rush,” Steven Lane, MD, director of Clinical Informatics, Privacy, Information Security & Interoperability for Sutter Health, said in an interview with EHRIntelligence. “The agencies say they want to follow HIV cases and want to know when people get Alzheimer's, but the pandemic changes things.”
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Although many public health agencies have outlined plans to track diseases like HIV or Alzheimer’s disease, there has been no acute push to actually automate this process. The lack of urgency has allowed a more manual process to persist.
But then COVID-19 happened.
“We've heard about how it takes a long time to get the test results and get the data to public health,” Lane said. “That's why the numbers are inadequate.”
Providers are also facing a challenge with individual public health jurisdictions. The process is very localized, where counties do not want to work directly with the state. This means the CDC and the state have to be on the same page to streamline the process.
“The truth is some local health jurisdictions within California have said, ‘Send it to us directly. We don't want to go get it from the state.’ APHL can actually send direct routes, and they've done this to LA County, San Diego County, and other counties in California,” Lane explained.
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“There's clearly a number of barriers getting providers on board, getting public health jurisdictions on board, and getting EHR vendors on board to develop and adopt an automated process.”
Additionally, public health has been chronically underfunded and underpowered in terms of technology solutions.
“In some states, initially in Florida and now in Oregon, public health agencies are saying, ‘This is great. We can see this data and we can integrate it. We can stop our manual reporting process.’ In California, unfortunately, it's come to light that agencies actually need to do a major upgrade of their technology solutions in order to be able to say the same thing,” Lane continued.
“For us as providers, it's great to know that we're doing more rapid, more complete, more high-quality reporting, but we still have to maintain this parallel manual process.”
Manually exchanging and reporting information is inefficient, expensive, and unreliable. At Sutter, Lane and his team have worked to overcome that issue by using clinical direct messaging tools from Surescripts.
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“For a number of healthcare provider organizations, this would be a good thing to do,” Lane explained. “But until providers believe they can save money by not doing the manual process, they are not going to invest even the 100 person-hours that they take to stand this up.”
The tool allows Sutter Health to get the information to relevant public health jurisdictions much more quickly than the prior paper fax process.
The tool aims to connect clinicians, pharmacists, and other healthcare professionals with patient health information, even if a patient is moving between multiple care settings. Providers also use this interoperability tool to exchange consultation notes and referrals.
“What we've heard and what we’ve seen in the press recently is a lot of people saying, ‘public health isn't getting enough data,’” Lane explained.
“There was a piece in the New York Times recently about how the fax machine is the bottleneck that's getting in the way of public health getting this data. Nobody needs to be using the fax machine at this point, but this is ready-made for rapid implementation solution that automates all of that.”
With major EHR vendors adopting this tool or building similar technology, providers will be more likely to expedite this process.
“Clinical direct messaging has a great background in terms of the work that went into developing it,” Lane said. “We should be doing everything we can to encourage its use and implementation across the board and across the country so that all the public health jurisdictions can make use of this data as quickly as possible.”
One potential option would be to legislate an incentive-based model for public health agencies and providers to adopt clinical direct messaging, Lane recommended.
“We have incentives for people to do syndromic surveillance and electronic lab reporting,” Lane said. “There are multiple means by which data can be pushed from provider organizations out to public health. This one is potentially the most robust data set, and it's well-defined, legally sanctioned, and incredibly timely.”
“A lot of public health agencies are getting their electronic lab report feeds,” Lane continued. “They know that somebody had a positive test, but as we've heard repeatedly, they don't have robust demographic data. They don't have any data about the concurrent comorbid conditions. So, that richer data set is available inside the electronic case reporting.”
To enhance this process, Sutter Health has spent the last 10 years developing a methodology for public health entities to query over the Carequality framework for current clinical data. Lane and his team are utilizing the standard space, document-based exchange that is already in place under their query-based document exchange implementation guide.
“It's great for us to push data out to public health,” Lane continued. “For example, a lab test is done and the diagnosis was made, but then public health needs to do a case investigation, a case follow-up, and contact tracing. But what they really need is a way to get current information. They need to be able to ask specific questions about pregnant women or about pediatrics, for example.”
The state of Washington has implemented this methodology into its workflow and the state will be able to launch queries across the Carequality framework in order to download current patient data. He also said California is in the midst of finding a vendor within the month to implement the same process.
“It's important to see this electronic case reporting as one type of push data messaging from providers to public health, and then that closed loop with the reportability response,” Lane concluded. “But then, the ability for public health to be able to pull data and make queries is the other side of that coin, and one that we're also working on here at Sutter.”
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July 21, 2020 at 08:30PM
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